Utility of risk-based chlamydia testing in primary care: analysis of retrospective surveillance data among women in Melbourne, Australia
Anna L. Wilkinson A B J , Kathleen McNamee C D , Carol El-Hayek A , Eric P. F. Chow F G , Catriona S. Bradshaw F G , Norm Roth H , B. K. Tee I , Mark Stoové A B and Margaret Hellard A B EA Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
B School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia.
C Family Planning Victoria, 901 Whitehorse Road, Box Hill, Vic. 3128, Australia.
D Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia.
E Infectious Disease Department, Alfred Health, Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia.
F Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia.
G Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 89 Commercial Road, Melbourne, Vic. 3004, Australia.
H Prahran Market Clinic, Pran Central, Mezzanine Level, Cnr Commercial Road and Chapel Street, Prahran, Vic. 3181, Australia.
I The Centre Clinic, 77 Fitzroy Street, St Kilda, Vic. 3182, Australia.
J Corresponding author. Email: anna.wilkinson@burnet.edu.au
Sexual Health 14(3) 268-273 https://doi.org/10.1071/SH16202
Submitted: 25 October 2016 Accepted: 7 February 2017 Published: 7 April 2017
Abstract
Background: Chlamydia (Chlamydia trachomatis) continues to be a public health challenge in Australia, with some contention as to the best screening approach. In the present study we examined chlamydia testing, positivity and sexual behaviour among women with the aim of informing targeted testing among women aged ≥30 years. Methods: A longitudinal analysis was conducted on retrospective surveillance data collected among women attending general practice, family planning and sexual health clinics participating in sentinel surveillance in Melbourne, Australia. Women were aged ≥16 years and underwent urogenital testing for C. trachomatis (chlamydia) at participating clinics between 2007 and 2014. Chlamydia incidence was calculated as positive chlamydia tests over person-years (PY) among women and reported by 5-year age groups. A Cox regression model examined correlates of a positive chlamydia test among women aged ≥30 years. Results: In all, 36 770 women contributed 46 432 PY and 52 395 chlamydia tests, of which 2895 were positive. The overall chlamydia incidence rate was 6.2 per 100 PY (95% confidence interval (CI) 6.0–6.5). Chlamydia incidence declined with age, plateauing to <5 per 100 PY among women aged ≥30 years. Among women aged ≥30 years, being born in North-East Asia (adjusted hazard ratio (aHR) 2.9; 95% CI 1.9–4.5) and reporting multiple partners (aHR 2.5; 95% CI 1.8–3.5) in the past 12 months were associated with a positive chlamydia test. Conclusions: Chlamydia control remains challenging in Australia and optimising testing in primary care is a key priority. The results of the present study suggest that, at least among women aged ≥30 years, chlamydia testing should be risk-based and informed by appropriate sexual history taking.
Additional keyword: risk behaviour.
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